title: Twenty-year trends in the incidence of stroke complicating acute myocardial infarction: Worcester Heart Attack Study.
abstract: BACKGROUND
  Given the improved survival of patients after acute myocardial infarction (AMI), more patients are at risk for cerebrovascular complications of AMI. Trends in the magnitude of stroke in the setting of AMI are not well characterized, however, and neither have contemporary trends in the hospital death rates of patients developing acute stroke been examined.
  
  
  RESULTS
  Of 9220 patients without a history of stroke hospitalized with confirmed AMI between 1986 and 2005 in all greater Worcester medical centers, 132 (1.4%) experienced an acute stroke during hospitalization. The proportion of patients with AMI who developed a stroke increased through the 1980s and 1990s but declined slightly thereafter. Advanced age, female sex, a previous myocardial infarction (MI), and the occurrence of atrial fibrillation during hospitalization were associated with a greater risk of stroke. Receipt of a percutaneous coronary intervention during hospitalization was associated with a lower risk of stroke. Compared with patients who did not experience a stroke, patients developing a stroke in the 1990s were approximately 3 times more likely to die during hospitalization (odds ratio [OR], 2.91; 95% confidence interval [CI], 1.72-5.19), whereas those experiencing a stroke in the 2000s were 5 times more likely to die (OR, 5.36; 95% CI, 2.71-10.64).
  
  
  CONCLUSIONS
  Although the incidence rates of stroke complicating AMI have declined somewhat since 1999, there is not a corresponding decline in the odds of dying during hospitalization in those developing a stroke. Although contemporary therapies may be reducing the risk of stroke in patients with AMI, more attention should be directed to improving the short-term prognosis of these high-risk patients.
authors.affiliation: Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA. jane.saczynski@umassmed.edu
authors.forename: Jane S
authors.initials: JS
authors.lastname: Saczynski
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Spencer
authors.forename: Joel M
authors.initials: JM
authors.lastname: Gore
authors.forename: Jerry H
authors.initials: JH
authors.lastname: Gurwitz
authors.forename: Jorge
authors.initials: J
authors.lastname: Yarzebski
authors.forename: Darleen
authors.initials: D
authors.lastname: Lessard
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D009203:Myocardial Infarction / Q000150:complications / Q000453:epidemiology*; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology